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Intraoperative blood pressure targets (April 2023)
Intraoperative episodes of hypotension or hypertension increase the risk for adverse cardiovascular outcome, but the optimum intraoperative blood pressure target is unclear. In a multicenter randomized trial comparing a hypotension-avoidance strategy (mean arterial pressure [MAP] target ≥80 mmHg) versus a hypertension-avoidance strategy (MAP target ≥60 mmHg) in nearly 7500 noncardiac surgery patients receiving long-term antihypertensive medications, the incidence of composite cardiovascular morbidity and mortality was 14 percent within 30 days, with no difference between strategies1. Intraoperative episodes of hypotension or hypertension should be avoided or promptly treated based on the presumed cause, timing, and preexisting comorbidities. Further research regarding best strategies for different populations is needed. (See “Hemodynamic management during anesthesia in adults”, section on ‘Blood pressure targets’.)